Esophageal Stents: Is Fluoroscopy Necessary?

Aims Self-expanding metal stents (SEMS) are used in the treatment of various esophageal conditions, such as strictures, perforations, and fistulas. They can be placed under fluoroscopic guidance (FG), endoscopic guidance (EG), or a combination of both. However, few studies directly compare these approaches. To assess and compare the safety and feasibility of SEMS placement under FG and EG, based on the experience of our institution.

Methods This is a retrospective study of patients who underwent esophageal SEMS placement between January 2011 and December 2023. Stents were placed either with fluoroscopic support or under direct endoscopic visualization. Data were collected regarding immediate/early complications (< 1 month post-insertion) and late complications (> 1 month post-insertion).

Results A total of 103 patients who underwent 114 SEMS placement procedures were included. The main indications were malignant esophageal stricture (90%), tracheoesophageal fistula (5.8%), and malignant extrinsic compression (2.9%). The majority of patients were male (78.6%) with an average age of 69.4 years. SEMS placement was performed under FG in 60 patients and EG in 43. Early complications occurred in 10.7% of patients in the FG group and 11.7% in the EG group (p=0.36). The most common complications were pain, vomiting, malposition/migration, bleeding, and dysphagia. Late complications were recorded in 6.8% of patients in the FG group and 11.7% in the EG group (p=0.67), including tumor invasion/growth, stent migration, esophageal fistulas, and food impaction [1].

Conclusions SEMS placement under fluoroscopic and endoscopic guidance is safe and accurate, with no statistically significant differences in complication rates between the two approaches. Both techniques are effective in treating malignant esophageal strictures and other conditions.

Publication History

Article published online:
27 March 2025

• References

• 1 Chandan S, Mohan BP, Khan SR. et al. Clinical efficacy and safety of palliative esophageal stenting without fluoroscopy: a systematic review and meta-analysis. Endosc Int Open 2020; 8 (7): E944-E952